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Volume 17, Number 2 • Spring 2015

gonorrhea, TB, and HIV testing. Most remarkable is the broad diversity of services provided by a small staff. It is able to accomplish this because its staff members are highly cross-trained in challenging specialties (e.g., bacteriology, parasitology, mycobacteriology, and mycology). Although very successful, Tulare plans to become even more efficient in providing outstanding service as it continues to implement Lean practices.

Denise Lopez, MS, PHM, Laboratory Manager, Public Health Microbiologist, and Environmental Laboratory Accreditation Program Director for water testing, oversees Tulare’s lab, with consultation services provided by Robin Purves, MS, PHM, PT. TCPHL employs three milk technicians, two lab assistants, one office assistant, and five public health microbiologists (PHM), two of whom are dual-licensed PHM/clinical laboratory scientists.

Able to Accommodate High-risk Infectious Agents Located in Tulare, California, TCPHL rests in a 6,750-square-foot building built in 1992. The lab is connected to a 1920s-era building that served as the county hospital and now houses local government offices and a health clinic. In 2005, the lab gained a new BSL-3 suite and negative-air-pressure anteroom to accommodate high-risk agents and rapid terrorism rule-out or confirmation. TCPHL is responsible for supporting public health programs, testing in support of outbreak investigations, and public health emergencies in Tulare County and the surrounding regions in conjunction with the California Department of Public Health (CDPH) and the CDC.

Power of Harvest LIS & Copia Showcased in Lean Study Because of the implementation of Orchard’s lab solutions, TCPHL was able to monitor specific metrics comparing before and after LIS installation as part of its Lean study to determine how much more efficiency and cost savings were gained by implementing the Lean process. Orchard’s lab information solutions provide Tulare with ways to be more efficient and increase the quality of service. It is tracking the amount of personnel time saved, dollars saved, and how both time and dollars are redirected to value-added or revenue-generating tasks.

Harvest LIS & Copia Boost Tulare County Public Health Lab’s Lean Journey

inside this issue...Tulare County Public Health ..............................2Where in the World is Orchy? ............................3Spotlight On: Testing Team ...............................3Delivering Browser Reports to Copia .................4 Is Your Lab Ready for ICD-10? .............................7Featured ORC Question ......................................7 Medications Table .............................................82015 Training Classes ...................................... 102015 Symposium ............................................ 11

Tulare County Public Health Laboratory (TCPHL) is one of four labs to receive an exciting grant from the Centers for Disease

Control and Prevention (CDC), administered through the Association of Public Health Labs (APHL), to implement Lean practices. Lean is a quality improvement process that systematically looks at processes to eliminate waste and identify ways to improve efficiency and sustainability. The CDC funds APHL in promoting a lab initiative with the goal of encouraging projects focused on improving lab efficiency across the country. Harvest LIS & Copia as Lean Tools for Improvement What is unique about TCPHL’s Lean journey is that in addition to the Lean tools, it simultaneously implemented Orchard® Harvest™ LIS and Orchard® Copia® as additional quality improvement tools to boost its Lean success. Prior to Harvest LIS and Copia implementation, TCPHL worked with a rudimentary 12-year-old LIS that had only basic functionality and no structured data fields, therefore no ability to mine data. For example, to pull a report, manually typing paper counts into a spreadsheet was the only option, creating quite a burden for the staff. The old LIS was neither intuitive nor customizable, and was not nimble enough to keep up with improvements, evolving business and service needs, or surge capacity during emergencies.

Cross-trained Staff Allows for Broad Diversity of Testing TCPHL has a solid reputation in its area, annually performing approximately 42,000 tests with a budget of $1.2 million, with

its highest volume in dairy testing. It examines specimens from suspected cases of infectious and environmental diseases, including specimens from humans, water, milk, vectors, and the environment, along with drinking water testing, chlamydia/

See “Tulare County” on page 2.

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Still in progress, the Lean project, in conjunction with Orchard’s lab solutions, has saved nearly $30,000 extrapolated annually. Installation of Harvest LIS and Copia has had a direct measurable impact on each of the four projects listed below: 1. Test Ordering: Time reduced by up to 80%, resulting in savings

of more than $10,400 per year. 2. Specimen Accessioning: Increased capacity by 95%, equating

to savings (or redirection of labor) of $11,475 annually. TCPHL is now capable of accessioning 100,000 samples in the same amount of time it previously took to accession 15,000.

3. Data Mining: Costs decreased by an average of 92% per report, resulting in overall savings of more than $5,500 annually. Previously, creating a billing report cost $13 as compared to $5 using the new system. Reports such as turnaround time and rejection rate that were as high as $76 per report because of the manual labor involved now are projected to cost $0.

4. Reporting: Savings of more than $2,000 each year by auto-faxing reports.

Lean Basics A key concept is to make sure that Lean works for you and not the other way around. Denise Lopez says, “We don’t force the issue just because it worked one particular way in another facility. We are learning to be flexible and balanced with our approaches and to let the data drive the decisions.” The key to Lean is to make a process easy to do the right way. In other words, if there is a right way to do something, make that the easiest way. Lopez continues, “We look at the process first. When processes are made easy, it frees up staff to figure out how to improve the process rather than the mechanics of performing it. Changes become easier to communicate and incorporate. A better process also lowers the threshold of energy required to cross-train and stay proficient while ensuring a high level of quality is maintained.” Lisa Seliskar, PHM II, adds, “Lean provides a clear path from which you can accomplish your goals. It provides the structure necessary to make trackable progress and that structure in a group setting gives everyone the direction they need to work together.”

Tulare CountyContinued from page 1.

Chartered Quality Institute (CQI) Aided by Strong IT Solution Lean is all about continuous quality improvement, so TCPHL is at the beginning of its journey. Tulare’s lab professionals are looking forward to the possibilities and opportunities as they continue to streamline their processes. They want to be able to provide outstanding service to all of their partners in the most effective way possible, and adopting Lean, together with a strong lab IT solution, has given them a great start. “We still have work to do but we are already definitely seeing great benefits,” says Lopez.

Find Your Lean Rhythm: “It’s Contagious!” Cynthia Bogert, Milk Tech/Lab Assistant, describes the Lean journey as a new way of thinking outside the box. She says, “We’ve been so immersed in Lean that I’ve been doing it at home. I’ve actually started thinking and talking in Lean terms.” In spite of sharing the fact that initially there was a bit of a learning curve, Cynthia has readily embraced the Lean culture. “You find your own rhythm,” she explains. “You are able to take certain tasks and look at why it takes one person 10 minutes and

another 15 minutes, and then analyze that and take the good practices from both and combine those into a better overall process.” She continues, “Lean is contagious. At first nobody likes change. You think, ‘How will we find time to do this?’ But once you start, it just all falls into place. Together with Harvest and Copia, we have been able to make everything so much faster.”

More Lean to Follow Orchard is making a case study available detailing some of the processes of TCPHL if you are interested in learning more about Lean basics and/or TCPHL’s Lean journey. APHL invited the TCPHL staff to serve as subject matter experts, providing information and lessons they learn to public health labs across the country that are interested in learning more about Lean for their organizations. As TCPHL continues “Leaning” its workflow, we will continue to monitor its progress and help share its trials and successes.

IMPROVEMENTS MADE USING LEAN WITH HARVEST LIS & COPIA

Decreased cost of data mining by an average of 92% per report, leading to annual savings of more than $5,500.

Increased specimen accessioning capacity by 95%, equating to savings (or redirection of labor) of $11,475 annually.

Decreased cost of data mining by an average of 92% per report, leading to annual savings of more than $5,500.

Reduced test ordering time by 80%, resulting in potential savings of more than $10,400 annually.

Technical Support: (800) 571-5835 3

Orchard Software’s beloved mascot Orchy™ has traveled to a new destination on his never-ending sightseeing journey. Orchy has decided to take some

much needed time to relax and enjoy the finer things in life at one of the most luxurious hotels in the world. This sail-shaped building has been referred to as “the only seven star hotel in the world.” If you think you know where Orchy is, send your response to news@orchardsoft.com by May 15th to be eligible to win an Orchard prize package.

The last time we saw Orchy, he was vacationing at the Trapp Family Lodge in beautiful Stowe, Vermont. The lodge is largely known for its ties to the 1965 Academy Award-winning film The Sound of Music. The resort’s architecture is modeled in an Austrian fashion and has beautiful mountain views.

Christy Carie of Good Samaritan Hospital correctly guessed Orchard’s location and was selected as the winner of the contest. Make sure to visit the Orchard website to see where in the world Orchy has been!

Where in the World is Orchy?

Spotlight On: Orchard Software’s Testing Team

Orchard Software’s Testing Team is an essential part of the Development Department that is tasked with testing the

new features that go into releases of Orchard Software’s products. The team validates the functionality of the different components by answering the question of “What would happen if I did this?”

The team is composed of 13 members; nine software test analysts, three senior test analysts, and one software test manager. The group values experience and has three members who have been with the company for a decade each and two who have over five years tenure with Orchard Software. These employees come from diverse career backgrounds in testing, technical support, programming, and life science fields.

The team puts the programs through a vast array of scenarios to ensure that everything works as expected. Software test analysts may have to check from anywhere between 150-300 changes for each new release of the software for Harvest LIS, Copia, and Orchard Pathology. These analysts use regression checklists to ensure the validity of the integration of the changes with the system. Orchard Software is proud of its Testing Team and grateful for all of their hard work and dedication in making excellent products. We look forward to what the future holds in terms of each product and the efforts the team will bring that will make each one a success.

From left to right (front Left): Cindy Stecker, Chris Barton, Kristen Zwick, Christy Healy, Tom Carter, Charles Virgne (back row): Heather Ashburn, Renee Impson, Matthew Champion, Julia Niemeyer, Victor Ingellis, Kenny Greimann, Curtis Farley

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Expand Analytics from the Lab to Outside Clients by DeliveringHarvest LIS-generated Browser Reports to a Copia Location Inbox

In an effort to expand the use of laboratory analytics, we have added a feature to Orchard Copia that allows laboratorians

to automatically send browser reports to a specific Copia location inbox. This feature allows the user to drop a file (supported file formats are txt, pdf, gif, jpg, bmp, tiff, png, or wmf ) into a designated folder that is identified at the host level in Copia. Copia will periodically scan this folder, retrieve any files that exist, and attach them to the other reports tab within the location inbox for the desired location.

How Does It Work? The file is attached to the location in the inbox based on the file name itself. The filename should include the host code saved in Copia for the location on the host that the file-drop folder is

set for. The location host code needs to be contained within the filename; it does not have to start or end with the host code. The name can help the user determine what is in the document. For example, Supply List_loc1.1.pdf, where “Supply List” is the useful name for the document and “loc1.1” is the location’s host code.

You can find the host code for a particular location by navigating to the Locations administration page under Basic Setup and selecting the desired location. Within the location, select the Host Codes tab to view the location’s associated host code(s).

Below is a reference of the location of this document. As you can see, the location’s host code is loc1.1.

Technical Support: (800) 571-5835 5

news@orchard is published quarterly by:

Orchard Software Corporation 701 Congressional Boulevard, Suite 360 Carmel, Indiana 46032 If you are not on our mailing list and would like to be, please call us at (800) 856-1948, fax us at (317) 573-2528, or email us at news@orchardsoft.com. Contributing authors & editors: Michael Brazitis Daphne Davis Audrey Lorraine Kerry Foster Kim Futrell Christine HendersonChris Livengood Debbie Schilling Bodie Shallenberger Meg Stanage John Wallihan Katherine WertzNancy Stoker Wendy Forgey If you have any questions or suggestions, please contact our publishers, Michael Brazitis and Sarah Goguen, or editor, Kerry Foster, at (800) 856-1948.View the newsletter online at: www.orchardsoft.com/newsletters

Configuring the Interface Within Copia, a small amount of setup is required to utilize this feature. To access the settings, go to the Hosts administration page under Basic Setup. On this page, select the host you would like to configure. Once selected, click the Interface Configuration button in the center of the page. The Interface Configuration page will open. Toward the top of the page, a text field named Inbox Document Path is available. Type the local file path where the documents will be saved into the field. You can click the Test button to ensure the path is valid and Copia can read it.

Once this is configured, you can scan or save the image or document into the folder coinciding with the document path configured above.

Copia continually scans the folder listed on the inbound host settings. As soon as a file is dropped into the folder, it will be picked up by Copia and then parsed in the inbound queue. Copia will then attempt to drop the file in the proper location inbox based on the file name that includes the appropriate location host code.

See “Expand Analytics” on page 6.

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Sending Harvest LIS Browser Reports to Copia Within Harvest LIS or Orchard Pathology, you can generate a browser report using any browser and search criteria you like. Once the report has been generated, there are three options for transmitting the report to Copia: • The first method is to export the browser results. The Harvest LIS export feature will export the results in a .csv format that you

can open and manipulate in Microsoft Excel. Once the file is exported and opened in Excel, you can save the document as a PDF in the directory configured previously.

• The second method is for when no further manipulation of the browser results is needed. You may click the Print button within the data browser window and select a PDF print driver to generate a PDF version of the report.

• The third method allows you to export the .csv file directly to the preconfigured file location. The only caveat with saving a .csv file (or any other non-supported file type) is that the file will download to the local workstation when the Copia user retrieves it rather than opening directly within Copia.

This feature is included in Orchard Copia 5.0.130130 and newer. For more information on Copia or the configuration of this feature, contact Technical Support at (800) 571-5835.

Expand AnalyticsContinued from page 5.

Technical Support: (800) 571-5835 7

Is your lab ready for ICD-10? We can help with our ICD-10 Conversion Package.

The switch will flip to ICD-10 on October 1st, 2015. Make sure you are ready! If you use Orchard’s systems for ICD

coding, in order to transition from ICD-9 to ICD-10, you must have Orchard Harvest LIS and Orchard Pathology v9.0 or higher. If you are not currently using v9.0 or higher, we suggest you upgrade as soon as possible in order to be ready for the October 1st transition date. Versions prior to v9.0 will not support ICD-10. ICD-10 offers a more comprehensive and advanced coding system that is necessary to provide in-depth analysis of disease patterns and treatment outcomes to take healthcare into the future. For more information on ICD-10, visit www.orchardsoft.com/icd-10/. For more information on upgrading to v9.0, visit orc.orchardsoft.com/pages/viewpage.action?pageId=22808507.

ICD-10 Conversion Assistance Available!

To ease the transition into ICD-10, Orchard

is offering a special ICD-10 Conversion Package to guide you through the testing process and ensure a smooth conversion. We recommend starting this process as soon as possible. Some of the highlights within the package include:

Install a test system Ensure backup of the live system Assist in establishing connectivity with participating vendors Promote planning and communication through weekly conference calls

Oversee validation and testing documents for each interface Import ICD-10 codes and GEM files Assist in testing Provide training

For more information on how Orchard can assist you through this transition, please contact your Orchard Account Manager at (800) 856-1948.

In Harvest LIS, how do you change the default location for an order choice? The Questions area of the Orchard Resource Center (ORC) provides a forum for timely and detailed answers to your inqui-ries regarding Orchard’s product line. Navigate to orc.orchardsoft.com/questions to sign into the main Questions page, where you can browse existing questions or topics, or even submit new questions. Searching for questions is as simple as typing the question or subject into the search bar of the main ORC page.

Questions are evaluated not just by Orchard staff, but also Orchard clients and other experts!

So, how do you change the default location for an order choice? Check out orc.orchardsoft.com/questions/36474232 to find the answer!

Featured ORC Question

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Orchard Harvest LIS Medications Table

In recent years, Orchard has installed Harvest LIS in more and more laboratories performing specialized toxicology testing. This testing ranges from simple drug screens and therapeutic drug monitoring to pain management compliance, pharmacogenetics, and pharmacogenomics.

Harvest LIS v10.0’s new Medications table improve the process of getting patient medication information into the system. The Medications table allows Harvest LIS to document medications on patients’ orders in a discrete and user-friendly format. In addition, Medications table entries and Lab Test table entries can be tied together to facilitate the use of order entry rules, result evaluation rules, and CPT rules. Furthermore, this tied relationship will aid in providing medication information on requisition, form letter, and report layout templates.

The Medications table, accessed via Table Setup, stores several pieces of information: • Name: Unique chemical or generic name. • Class: Pharmacological or user defined. • Alias: Common name, brand name, street name, etc. - The Aliases button opens an additional dialog and allows

entry of as many alternate names or codes for the medication as needed.

- Aliases are searchable when entering medications on a patient’s order, so you do not have to worry about making sure everyone memorizes one particular name.

- Aliases are not unique to account for formulations that contain more than one medication.

• Notes: Document miscellaneous notes about the table entry. • Inactive checkbox: If marked, this removes the selected record

from the list of active medications. • Common checkbox: If marked, this entry will appear on the

Common tab when adding medication information to an order.

• Tests: Displays a read-only list of the lab test(s) the medication is linked to.

- Linking of medications to lab tests takes place in the Lab Tests table.

• Search: Allows searching of the table for a specific entry. • Change Log: Displays all changes related to the selected record.

In addition to manually entering medications and aliases, there is an option to import these items using delimited files.

Adding Medications to an Order To add medications to an order, there is a new button on the Order Patient Samples window. In addition, a Medications button has been added to the Edit Sample Information window in the event this information needs to be added or edited after an order has been saved.

Technical Support: (800) 571-5835 59

Using the Medications button on either screen opens the Select Medications dialog. Users are presented with several options for finding and entering individual medications.

• The Previous tab lists any medications that have been used on the patient’s past orders within a definable time period. This tab is always present.

• The Common tab is present if one or more medications have been designated as “Common.”

• The All tab lists every available medication and alias entered in the Medications table. This tab is always present.

• Following these three tabs is a tab for each active class as listed in the Medications table.

• The Search field allows the user to search for a medication by entering either the name or any alias.

Once a medication/alias is added to the selected list, all other matching entries of that medication/alias will be grayed out. Medications added using an alias appear in the selected list as “Name (Alias used).” However, once the order is saved, the medication is listed on the order using just the name.

Optional Columns New optional columns—Medications on Order, Test Medications (Order), and Test Medications (Order Choice)— are available for display in Work in Progress, Review Results, Send to Host, Result Browser, Order Choice Browser, Order Browser, Turnaround Time Report, and Overdue Order Choice Report. Test Medications is available for the Result Browser, Review Results, and Work in Progress (Tests). Medications on Order displays a comma-separated list of all medications tied to the order (i.e., medications the patient is reported to be taking). The Test Medications columns display a comma-separated list of all medications tied to any tests on the order, order choice, or test (i.e., medications being tested).

Layout Templates Medications on Order and Medications Tied to Tests field codes are available for custom report header layout templates.

Test Medications is available for custom report body layout templates in the Format Test Result and Format Unformatted Result sections.

Medications on Order and Medications Tied to Tests are available for use on requisition and form letter layout templates.

Rules Engine Medications are available for evaluation as a condition in order entry rules to: • Require the entry of medication information on an order/case. • Determine if the order contains testing for all medications

listed on the order. • Check for the presence or absence of tests tied to medications.

Orchard Harvest LIS & Orchard Pathology v10 Now Available!

Version 10.0, the most recent version of Harvest LIS and Orchard Pathology, is now available, as well as accompanying release notes. Additional details about the new version will be shared in June. If you are currently using v9.0 or higher, there is no anticipated hardware update required; however, we will be happy to verify the hardware at your facility prior to your v10 upgrade.

See “Medications Table” on page 10.

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Medications are available for evaluation as a condition in result evaluation rules to: • Check for the presence or absence of medications on the order

and use that information to evaluate the results of tests with tied medications.

Medications and class are available for evaluation as a condition in CPT rules to check for the presence or absence of: • Medications on the order. • Tests tied to medications on the order. • A medication class on the order.

HL7 Orchard Harvest LIS v10.0 has the ability to send and receive a patient’s current medications in HL7 messages, including HL7 2.5.1. Medications are sent in a special clinical info OBX segment and are only sent for HL7 message types that currently support clinical info OBX segments.

Orchard Copia Synchronization In the April 2015 release, Copia v6.0 will also support the medications feature. Once this functionality is available in Copia, medication names, aliases, and classes will be able to synch between Harvest LIS and Copia. As with any other synchronized elements, these items will become modifiable only in Copia.

Medications TableContinued from page 9.

2015 Training Classes

For more information, contact your account manager at (800) 571-5835 or visit www.orchardsoft.com.

Course Name Start Date End Date Course Close DateMay 2015 Harvest LIS System Administration 5/4/2015 5/8/2015 4/10/2015

May 2015 Micro Class 5/12/2015 5/15/2015 4/17/2015

May 2015 Copia Administration 5/12/2015 5/15/2015 4/17/2015

May 2015 Pathology 5/18/2015 5/22/2015 4/24/2015

May 2015 Copia Integration I 5/18/2015 5/21/2015 4/24/2015

June 2015 Harvest LIS System Administration 6/1/2015 6/6/2015 5/8/2015

June 2015 Harvest LIS AU 6/8/2015 6/12/2015 5/15/2015

July 2015 Harvest LIS System Administration 7/13/2015 7/17/2015 6/19/2015

July 2015 Micro Class 7/20/2015 7/23/2015 6/26/2015

July 2015 Copia Administration 7/20/2015 7/23/2015 6/26/2015

July 2015 Copia Integration II 7/27/2015 7/30/2015 7/3/2015

July 2015 Pathology 7/27/2015 7/31/2015 7/3/2015

August 2015 Harvest LIS System Administration 8/3/2015 8/7/2015 7/10/2015

August 2015 Harvest LIS AU 8/10/2015 8/13/2015 7/17/2015

September 2015 Harvest LIS System Administration 9/14/2015 9/18/2015 8/21/2015

September 2015 Micro Class 9/21/2015 9/24/2015 8/28/2015

September 2015 Copia Administration 9/21/2015 9/24/2015 8/28/2015

September 2015 Pathology 9/28/2015 10/2/2015 9/4/2015

October 2015 Harvest LIS System Administration 10/5/2015 10/9/2015 9/11/2015

October 2015 Harvest LIS AU 10/19/2015 10/22/2015 9/25/2015

November 2015 Harvest System Administration 11/2/2015 11/6/2015 10/9/2015

November 2015 Micro Class 11/9/2015 11/12/2015 10/16/2015

November 2015 Copia Administration 11/9/2015 11/12/2015 10/16/2015

November 2015 Pathology 11/16/2015 11/20/2015 10/23/2015

December 2015 Harvest System Administration 12/7/2015 12/11/2015 11/13/2015

December 2015 Harvest AU 12/14/2015 12/17/2015 11/20/2015

Technical Support: (800) 571-5835 511

TO REGISTER, VISIT orchardsoft.com/symposiums

We look forward to seeing you there!

Hotel & Transportation Information If you are ready to book your hotel room, a dedicated room-booking website has been created for this event, so you will be able to make, modify, and cancel your hotel reservations online. We have a block of hotel rooms available at $139.00 single/double, plus tax. If you prefer phone reservations, please use the dedicated Group Reservations phone number, (888) 258-7501, and be sure to mention that you will be attending the Orchard User Group & Symposium in order to access the special hotel room rate. The deadline to guarantee a reduced rate is Tuesday, May 26th, 2015 (providing the group room block has not been filled). Thereafter (or if the room block has been filled), rooms are subject to availability. To arrange ground transportation to the hotel, visit the Mears Transportation website.

Registration There is no charge to attend the event; however, we ask that you complete the registration form.

2015 ANNUAL USER GROUP & SYMPOSIUM June 17th & 18th.

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701 Congressional Blvd., Suite 360Carmel, Indiana 46032

Phone: (800) 856-1948Fax: (317) 573-2528

Email: news@orchardsoft.comWebsite: www.orchardsoft.com

Technical Support: (800) 571-58358

2015 Orchard Software Event CalendarDate Trade Show/Event Location

4/12 - 4/16/15 Healthcare Information and Management Systems Society (HIMSS) Chicago, Illinois

5/5 - 5/6/15 Executive War College New Orleans, Louisiana

5/5 - 5/8/15 Pathology Informatics Pittsburgh, Pennsylvania

5/7 - 5/9/15 Becker’s Hospital Review Chicago, Illinois

5/18 - 5/21/15 Association of Public Health Laboratories (APHL) Annual Meeting Indianapolis, Indiana

6/17 - 6/18/15 Orchard Software User Group Meeting & Symposium Orlando, Florida

7/26 - 7/30/15 American Association for Clinical Chemistry (AACC) Clinical Lab Expo Atlanta, Georgia

9/8 - 9/12/15 PAINWeek Las Vegas, Nevada

Register NOW for the Orchard Symposium, June 17th & 18th in Orlando, Florida!

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